Tumor Thrombus of the Inferior Vena Cava Resulting from Renal Carcinoma: A report on 12 autopsied cases

Abstract

126 consecutive autopsies on cases of renal carcinoma (hypernephroma) were studied with regard to growth of the tumor into the inferior vena cava (“Geschwulstthrombose”). This was demonstrated in 12 cases (9.5%). The total series included several small tumors, discovered by chance, which had almost certainly been of no clinical importance. The length of the tumor thrombus varied considerably. In 3 cases it extended as far as to or into the right side of the heart. Both the pathological findings and the clinical manifestations were very variable. In several cases renal symptoms were few or even completely absent. Tumor invasion of the vena cava was considered pre-mortem in 1 case and demonstrated at nephrectomy in 1 case. In the other cases the tumor thrombus was first revealed at autopsy. Cavography was not used in any of the cases in this investigation. This series and the observations of other authors indicate that the presence of a renal tumor thrombus does not necessarily mean that there are metastases. In 4 cases metastases could not be demonstrated, and in 1 case there was just a single pulmonary tumor embolus with considerable regressive changes. The prognosis in cases of renal tumor thrombus in vena cava is therefore not unreservedly hopeless, assuming that it is technically possible to remove the thrombus together with the carcinomatous kidney.